UB staff carrying out activities at other centers

Name and surname*

Faculty, Department, unit or service*

Collective*

E-mail*

Add the details of the person at the UB who authorises/tutors the activityYesNo

Company name of the company/institution*

Address

Contact person*

Contact telephone*

E-mail*

Planned start date of activity*

Planned duration of the activity

Description of the type of work*

Space/s where the activity will take place*

Specifies the risk activities*
("Ctrl +" to select more than one option)Scuba divingImmersionSkipper of boats or similar vesselsHigh mountainClimbingCavingArchaeological excavationsDriving special vehiclesOthers

Do you have a valid medical aptitude document with annual validity?*YesNo

Have you given up taking your health exam?*YesNo

Have you received the informative documentation on the risks and preventive measures of the activity to be carried out?*YesNo

Remember that before starting activities in other institutions or centres outside the UB, you must be provided with preventive information about the risks of the area you will be entering, the preventive measures to be applied, the personal protection equipment you will need, the rules of action in the event of an emergency, and the specific training required for the development of these activities.

Have you completed training in Occupational Risk Prevention?*YesNo

Indicate which course(s) you have taken*
("Ctrl +" to select multiple options)Basic Risk Prevention 4hORP training: Oficines environmentORP training: LaboratoriesSafety and Health: Oceanographic CampaignsSecurity and Health: Arctic and Antarctic ZonesSafety and Health: Maritime, Lake and River AreasSpecial waste managementFirst aidOthers

If you carry out risk activities that require a certificate or specific training, attach it to the corresponding section (Maximum size per file: 3Mb | File format: pdf, jpg or png)
Scuba diving

Skipper of boats or similar vessels

First aid or life saving

Others

Does your activity require Personal Protection Equipment (PPE) to be carried out safely?*YesNo

Signature*
(Draw your signature in the box)

Right to information regarding the processing of personal data
(1) The responsible for the processing of your data is the General Secretary of the University of Barcelona. (2) The purpose of the processing is to manage the prevention of occupational hazards. (3) You have the right to access your data, rectify them, delete them, oppose their processing, request their portability and the limitation of the processing, in certain circumstances. (4) You can consult detailed information on the aforementioned processing.

I declare that I have read the information right*

I declare that I undertake to provide the information on the processing of UB personal data that appears on the first page of this form to the employees of the organisation I represent*

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